Date: Sun, 7 Dec 1997 16:32:10 +0800 (HKT)
From: William Stewart
Dear friends,
The following is a proposal for continued work on HIV prevention in
China.
Please forward to anyone you think might be interested, or have a couple
of dollars to throw our way.
***************************************************************
SOCIAL SUPPORT AND STD/HIV EDUCATION AMONG MEN WHO HAVE SEX WITH MEN IN
BEIJING, CHINA
1. Men who have sex with men in China
Homosexuality has a long and documented history in China. Imperial
records from the Han dynasty recount stories involving same sex
affectionate and erotic relationships, episodes from which some of the
terms used to refer to homosexuality today are drawn. Classical Chinese
literature abounds with homosexual vignettes. In the twentieth century
however, official acceptance of homosexuality has been reversed.
Although China has no specific law on homosexuality, men who have sex
with
men in China are routinely affected by other legislation, including
public
order legislation. Reports throughout the country indicate that police
harassment, arrests, detention, beatings and rape in detention are
unfortunately all too common. Few of these incidents are subject to
proper reporting since many of the men concerned are unwilling to come
forward. In addition, social sanctions against homosexuality are
maintained by other quasi-official means. The Chinese medical and
psychiatric associations still maintain homosexuality in the official
manual for categorisation of mental disorder, despite it having been
removed from international reference manuals such as ICD-10 and DSM-IV.
Moreover, homosexuality is subject to social sanctions in the form of
stigmatisation, family pressure to marry, lack of living space for those
who do not marry and constant criticism through media.
Despite this bleak picture the Chinese community of gay men is
increasingly large and increasingly visible. Some Chinese cities have
gay
bars and discos and meetings are frequently held in individuals' homes.
A
network of personal contacts spans the country, and facilitates
communication. The internet is increasingly used by Chinese in China
and
abroad for maintaining contact. Some, though unfortunately few, men are
able to be open about their sexual orientation at work and with family
members.
In addition to this, there is a large incidence of same sex sexual
behaviour among people who would not necessarily consider themselves as
gay or homosexual. Research studies have indicated that 0.5% of married
Chinese in cities and 2.3% in urban areas said they engaged in
homosexual
activities, and 7.5% of college students in one survey said that they
had
same sex affectionate relationships. Many parks, newspaper notic
boards,
toilets, public bathhouses or backstreets in China are known as places
where men can meet one another for sex.
One side effect of this growth of possibilities for sexual interaction
is
the potential for HIV spread among men who have sex with men. Condom
use
is low, and knowledge about HIV and other STD is cloudy. Attempts to
provide this knowledge are hampered by official attitudes. In Beijing
two
hospitals have reported that about a third of their HIV positive
patients
(12 out of 38 and 10 out of 33 respectively) were infected through male
to
male sex. Meanwhile the number of reported infections of other sexually
transmitted diseases in homosexual men increased 263% between 1993 and
1994.
2. Background to this proposal
In order to address some of these issues, in April 1997 a group of
concerned individuals in Beijing launched a beeper (pager) hotline to
answer questions about gay life in China, provide social support, and
information about sexually transmitted diseases and HIV. The hotline
provides confidential support through a revolving team of workers, each
of
whom have participated in two training sessions, one involving
information
on STD and HIV from a doctor at a Beijing Hospital and a public health
researcher at a Beijing university.
Initially this service was only advertised through the internet, by
networks of personal contacts. Notwithstanding this limited
advertisement, the hotline had received 30 calls from throughout China
by
the end of November 1997. These calls were varied in nature and a
number
of them required sustained counselling over a number of calls. The
hotline is now able to provide referral on to confidential HIV testing
facilities should they be required.
In addition to this the group also held a safe sex evening at a bar in
Beijing for World AIDS day 1997. Supported by a variety of private
donations, over 150 condom packs including condoms, lubricant, safe sex
information and details of the hotline facility were distributed. In
order to evaluate this activity a number of in-depth interviews will be
held which will also seek to elucidate information on HIV/STD needs,
concerns about HIV testing, and preferred forms of health education
activity. Cards with the hotline details have been distributed to some
personnel working in facilities such as STD clinics or other HIV
hotlines
where there is a possibility that homosexual men may refer and benefit
from peer support.
3. Future plans
The group has identified some priorities for extending their work.
These
are outlined below.
-- the continuation of safe sex activities. A one-off event was felt to
be likely to provide little impact on behaviours, and sustained
education
provision, through bars and ultimately parks and bathhouses is
envisaged.
Following the evaluation of the December 1 evening, it is hoped that
educational materials can be produced which are specific to men in the
mainland, since at present materials produced in Hong Kong are being
used.
-- the continuation of training for hotline volunteers. More support on
counselling issues and information about sexual health is needed and a
series of small group sessions for volunteers and interested others is
planned.
-- referral to HIV testing facilities. Many gay men in Beijing wish to
test for HIV but are deterred by fears about anonymity and consequences
of
testing positive. Although links have been made with a Beijing clinic
where testing can be provided anonymously, it is hoped that dedicated
materials discussing the advantages and disadvantages of testing can be
produced. In addition, activities are needed both to help hotline
volunteers in providing this advice, and in sensitising clinic personnel
to the needs of the homosexual community.
-- support for people with HIV. An HIV diagnosis often means social
difficulties, including ostracisation, even within the gay community.
As
a long term aim it is hoped that the hotline can provide referral to
social and emotional support for those who are diagnosed with HIV.
Financial support may be considered, particularly for men who have lived
by selling sex, and no longer wish to do this but have little other
option
for work.
4. Options for support
Because of the nature of official attitudes towards homosexuality in
China, gay community groups are unable to apply for funding or support
through government mechanisms. Whilst they can provide detailed
financial
accountability , they cannot guarantee the sustainability of work.
However, there are a number of ways in which support could be given,
detailed below:
-- provision of condoms and lubricant. At present condoms are bought by
members of the group, but ones recommended for anal sex are fairly
expensive at 44 RMB (5.4 USD) for a pack of twelve. A target of 12,000
condoms for distribution in the first half of 1998 would therefore
require
5400 USD. Lubricant to accompany these condoms, difficult to acquire in
Beijing and currently brought in from Hong Kong would cost 1463 USD. A
system of getting lubricant wholesale from Australia is currently under
investigation.
-- development of dedicated educational materials. Materials
specifically
aimed at mainland Chinese are needed both on safer sex and on HIV
testing.
500 USD would enable one of these sets to be produced for an initial
print
run.
-- workshops. Currently held in members homes, they are cheap to
organise, but covering of travel costs and materials would require 50
USD
per session. Two more sessions on HIV and STD are planned, whilst at
least two on counselling and support for people with HIV are needed.
-- copying of materials. The groups has access to materials on HIV and
STD produced by UNAIDS and the EC as well as gay organisations
throughout
Asia, but to copy them so that each member can have a copy would require
10 USD a set. Donations of other materials on lesbian and gay life and
on
health issues to develop a resource centre are welcome.
-- phone bills. THe beeper requires that the volunteer must return the
call, meaning that they pay phone bills. At present 100 USD a month
would
cover requirements, but it is hoped that the volume of calls will
increase
as word gets round. The annual fee for the beeper is 75 USD.
For any information on how to help in this community led project, or for
a
more detailed project plan, please contact, in the first instance:
Billy Stewart
billy@bltda.com.bta.net.cn
or call 6821 5888 call 7293 in Beijing
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